Healthcare Provider Details

I. General information

NPI: 1679400162
Provider Name (Legal Business Name): WALGREEN CO.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 COMMERCE CENTER DRIVE STE 100RX
SHELBY NC
28150-0000
US

IV. Provider business mailing address

1901 E VOORHEES STREET MS 790
DANVILLE IL
61834
US

V. Phone/Fax

Practice location:
  • Phone: 704-297-2011
  • Fax: 704-297-2060
Mailing address:
  • Phone: 847-527-2489
  • Fax: 847-527-2489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER PONCE
Title or Position: MANAGER
Credential:
Phone: 224-475-5702